UNIVERSITY OTOLARYNGOLOGY
FINANCIAL POLICIES & INFORMATION
University Otolaryngology strives to provide our patients with the finest quality medical care. University Otolaryngology would also like to provide our patients with clarification on some of our financial policies. This information is not all-inclusive; it is the patient’s responsibility to understand their insurance benefits and financial responsibilities.
CO-PAYMENTS – Most insurance plans require co-payments. It is usually a fixed dollar amount designated by your insurance company. Usually a co-payment amount is designated on the front of your insurance card. Co-payments are due at the time of your visit. A co-payment cannot be waived.
DEDUCTIBLES – Most insurance plans have deductibles. The deductible amounts vary by insurance plan. A deductible is the responsibility of the patient before their health insurance company will reimburse the healthcare provider. A deductible is the responsibility of the patient.
CO-INSURANCE – This is the part of your bill, in addition to a co-payment and/or deductible, the patient must pay to the healthcare provider. Co-insurance is usually a percentage of the allowed amount for a service or procedure.
UNCOVERED SERVICES – Medical insurance usually does not cover the entire cost of medical care, specific procedures, diagnostic testing and/or certain office visits. University Otolaryngology healthcare providers are not aware of your healthcare benefits and therefore are unaware if a particular service, test or procedure is covered by your insurance. It is the patient’s responsibility to know their insurance benefits and financial responsibilities.
PROCEDURES – Our healthcare providers will determine what procedures, if any, need to be done at the time of your office visit. Some of these procedures may be classified by your insurance company as surgical procedures. These procedures are separate and apart from the office visit charges. In these cases, the patient is responsible for the office visit charges and the charges for any services, test, or procedures performed.
Examples of Separate Services in ADDITION to the office visit include but are not limited to:
Audiology Services (hearing tests), CT Scans, Allergy Services, Physical Therapy, Vestibular Testing, FEEST
Examples of In-Office Medical Procedures include but are not limited to:
Flexible Laryngoscopy – this procedure involves using a fiberoptic scope to enter the nasal cavity and throat.
Nasal Endoscopy – this procedure uses a flexible or rigid scope with a light source to view the nasal cavities.
Cauterization of Nosebleeds – this procedure involves applying a chemical to stop the bleeding & packing.
Removal of Cerumen – this is the removal of impacted wax from the ear.
Binocular Microscopy – this procedure uses a microscope to obtain better visualization.
I have read and understand the “Financial Policies & Information” contained herein:
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Signature of Patient (or Legal Guardian) Date
Patient’s Name (printed)______